Information for trans and non-binary people seeking fertility treatment

Fertility may be the last thing on your mind when you’re experiencing the distress of having a body that doesn’t express your identity. Understandably, many trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you have treatment without preserving your fertility and then realise later on that you want a biological family. Thinking through all these issues now and understanding your options will help you make an informed decision.

Fertility treatment for trans people

Some medical treatments for gender dysphoria, including hormone therapy and surgery, can have an impact on your fertility. If you’re considering starting treatment to physically alter your body, or you’ve already started, find out what your options are for preserving your fertility.

How does medical treatment for gender dysphoria affect fertility?

Hormone therapy (oestrogen or testosterone) suppresses your fertility function and over time can lead to a complete loss of fertility. In some cases, people who stop taking their hormone therapy will have their fertility restored, although this is by no means guaranteed. Generally, the longer you are having hormone therapy the more your fertility is likely to be permanently affected.

If you think you would like biological children at some point and you haven’t started medical treatment or had surgery, you may wish to preserve your fertility by having your sperm, eggs or embryos frozen and stored for later use in fertility treatment.

Depending on your situation, you, your partner or a surrogate may undergo fertility treatment (such as IVF) using your stored sperm, eggs or embryos. Having genital reconstructive surgery will prevent you from having biological children without the use of a surrogate or interventional fertility treatments. Relevant genital surgery includes having a salpingo-oophorectomy (removal of the fallopian tubes and ovaries), hysterectomy (removal of the womb), orchidectomy (removal of the testes) and penectomy (removal of the penis).

Key facts:

Currently, it’s not possible to have children using your own sperm, eggs or embryos once you’ve had genital reconstructive surgery without prior storage.

Hormone therapies and medications can lead to loss of fertility

It is best to store your sperm, eggs, or embryos before medical treatments for gender dysphoria, if you wish to have children who are biologically related to you

If you decide to store your sperm, eggs or embryos or have fertility treatment your fertility clinic will give you the opportunity to talk to a counsellor

I haven’t started hormone therapy or puberty suppressing medication yet – what are my options for preserving my fertility?

If you’ve already gone through puberty you may be able to freeze your eggs or sperm and store them until you’re ready to use them in treatment.

Egg freezing involves taking fertility drugs to stimulate your ovaries and then collecting the eggs by a surgical procedure whilst you’re sedated. It is mostly very safe, although there is a risk of ovarian hyperstimulation, which can need hospital treatment and in very rare cases can be fatal.

Sperm freezing involves masturbating or undergoing vibratory stimulation to produce a sperm sample, which is then frozen and stored. If you do not feel comfortable producing sperm in this way, it is possible to extract the sperm in different ways (such as through surgical sperm extraction) although these involve more invasive surgical procedures.

Before puberty

If you haven’t gone through puberty yet and you’re keen to start hormone therapy or puberty suppressing medication as soon as possible, it may be possible for you to store your ovarian tissue or testicular tissue, which can be collected via a surgical procedure. These treatments are experimental and there have only been a very small number of resulting live births worldwide following replacement of the ovarian tissue. It is unclear at present how stored testicular tissue would be used to restore fertility: this has not been achieved yet. It’s also worth bearing in mind that very few clinics offer these treatments so you may need to travel some way on multiple occasions to have this procedure.

If you’ve already started hormone therapy or you’re taking puberty suppressing medication you should speak to a fertility specialist. They will probably recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. This means your ovaries may start to ovulate again or your body may start producing sperm, generally over a few months.

Some Trans and non-binary people find it distressing to come off their hormone therapy and may consider other options for having a family, such as using donated sperm or eggs in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family.

Using donated eggs and sperm

I’ve been undergoing hormone therapy and am about to go for genital reconstructive surgery, what are my options for preserving my fertility?

If you’re ready for genital reconstructive surgery, it may be possible for your surgeon to collect ovarian tissue or collect sperm via surgery which you can store for future fertility treatment. The only way in which the ovarian tissue can be used at the moment is by replacing it back in you: it cannot be put in another person, and eggs cannot be grown from it ‘in the lab’ at the moment, though this may become possible in the future. You should discuss this with a fertility specialist.

You can’t have children using your own sperm, eggs or embryos once you’ve had genital reconstructive surgery, unless you store your sperm, eggs or embryos prior to surgery.

How long can I store my eggs, sperm, embryos or reproductive tissue?

The standard storage period for eggs, sperm, embryos or reproductive tissue is 10 years but it can be extended to up to 55 years if you are, or are likely to become, prematurely infertile, for example as a result of hormone therapy or genital reconstructive surgery. Your clinic should advise you how to give consent to your storage being extended beyond 10 years.

How will my eggs, sperm or reproductive tissue be used in treatment?

If you’ve stored eggs, they’ll need to be fertilised with sperm using intracytoplasmic sperm injection (ICSI) or IVF and then the resulting embryos will be transferred to a person’s uterus (this could be your partner, yourself if you’ve kept your uterus, or a surrogate).

If you’ve stored sperm, your sperm can be used in intrauterine insemination (IUI). Alternatively, your sperm can be mixed with eggs from your partner, or donor in an IVF or ICSI treatment. If you’ve had to stop hormone therapy in order to collect and store your sperm, the sperm quality may not be as good.

Storing sperm is the only established way to preserve male fertility. Researchers are currently exploring testicular tissue freezing (i.e either as individual cells or as a piece of tissue) as a fertility preservation option. The cells or tissue could later be injected or transplanted back to potentially restore natural fertility. Alternatively, in the future, researchers may be able to produce sperm from these cells in a lab. This sperm could then fertilise an egg in a lab and be used in fertility treatment. However, this research is at its very early stages and would need a change in UK legislation for it to be allowed for treatment. Currently no births have been reported, following testicular tissue freezing.

If you’ve stored ovarian tissue (i.e. a whole ovary or pieces of tissue from an ovary, containing eggs), it could later be transplanted back to potentially restore natural fertility. Currently only a few centres in the UK offer the service of storing ovarian tissue. The use of frozen ovarian tissue in fertility treatment is still experimental.

What kind of tests will I need?

Before your eggs, sperm or embryo(s) are frozen you need to be screened for various infectious diseases and genetic conditions by a blood test. Make sure you talk to your clinic about your plans for using your stored material so they can give you all the information you need.

Before you consent to storage or treatment you and, if applicable, your partner may also need to have blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.

If you wish for your embryos to be used in another person’s treatment (e.g. in a surrogacy arrangement), the same screening rules on donation apply. You and if applicable your partner will both be required to have further screening tests for cystic fibrosis, karyotype (chromosome analysis), cytomegalovirus, syphilis and gonorrhoea. In addition, your blood groups will be checked. If surrogacy is something you may consider in the future discuss this with your fertility clinic before storage.

What paperwork will I need to complete?

Your clinic will ask you to complete consent forms depending on the type of storage or treatment you’re having. If you’re planning on using a donor or surrogate later on, you’ll need to give separate consent for this. Find out more from our patient consent leaflets

If you’re not sure whether you’ll need to use your eggs, sperm or embryos with a donor or surrogate, you may want to initially consent to storage only. You can then update your consent later on – although make sure you’re aware of the additional screening requirements when storing eggs, sperm or embryos for use with a donor or surrogate (see question above).

Can I have fertility preservation treatment on the NHS?

This is not straightforward to answer, and is subject to change and may depend on where you live. Funding for storing your eggs, sperm or embryos before having medical treatment for gender dysphoria varies depending on where you live, with Scotland, Wales and Northern Ireland all making their own decisions about funding.

In England, funding decisions about storage and fertility treatment are decided locally by Clinical Commissioning Groups (CCGs). Some CCGs will fund treatment and others will not. At present, the National Institute for Health and Care Excellence (NICE), which provides guidelines to CCGs and medical professionals on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria.

The best thing to do is to talk to your GP as it can be tricky to find out exactly what’s available in your local area and if you’re eligible. Also bear in mind that even if you can have your eggs, sperm, embryos or tissue stored on the NHS, you may need to pay to use them in treatment later on.

In terms of funding, what are the next steps to having eggs, sperm or embryos stored or to have fertility treatment?

If you want to explore storage or getting fertility treatment on the NHS, your GP will need to make a referral to a local fertility service for investigation and discussion around the available options in your area. The GP will need to have details of your diagnosis and treatment plan from the Gender Identity Service you are under the care that will show if the treatment plan includes treatments that could impact on your future fertility.

If you’re paying for your own treatment you can contact a fertility clinic directly. We provide advice on how to choose the best clinic on our website as well as search for a clinic that's right for you with our Choose a Fertility Clinic tool.